Pediatrics Mod 3 Exam

Normal Vitals (Toddler: 1-3 Years)

• Respiratory rate should be 20-30.
• Heart rate should be 70-110.
• Blood pressure should be 90/56 mmHg.

General Characteristics of Toddlers

• Toddlers gain independence and experience slowed growth/development.
• They are in Erikson's stage of autonomy vs. shame and doubt, marked by negativism.
• Rituals are important to toddlers, and changes to routines should be avoided.
• Offering limited choices and avoiding negativity is beneficial.

Physical Development of Toddlers

• Birth weight quadruples by 2.5 years.
• Toddlers gain 4-6 lbs in weight and 4 inches in height per year.
• Brain growth slows down during this stage.
• The musculoskeletal system grows, and bones ossify.
• Respirations shift from mainly abdominal to thoracic.
• The protuberant abdomen flattens as muscle fibers develop.
• Toddlers eat 3 meals per day as digestive processes and stomach capacity increase.
• Potty training can begin, with bowel/bladder control usually complete by 2.5-3 years.

Sensorimotor and Cognitive Development in Toddlers

• Memory strengthens, and rituals involving trial, error, and repetition are important.
• Piaget's sensorimotor/preconceptual phase of development emerges rapidly, demonstrated by activities like matching games.

Development: 12-16 Months

• Children tend to imitate adults, seek parallel play, drink from a cup, hold a spoon, build a tower, and prefer finger foods.
• Toddlers will begin walking, following simple commands, and developing object permanence.

Development: 16-18 Months

• Toddlers become curious, and safety precautions are critical; parallel play is in full effect.
• Self-feeding improves, walking alone and backwards emerges, and symbolic language starts.
• Toddlers can point to familiar things/people and start understanding cause and effect.

Development: 24 Months

• Independence increases, the child becomes egocentric, and autonomy increases (saying "no").
• They build towers of 6-7 blocks, turn book pages, undress themselves, and can run, throw, climb, and jump.
• Imitating oral hygiene, using plural words, and developing likes/dislikes are seen.

Development: 36 Months

• Toilet independence is normally achieved between 2.5-4 years, depending on temperament, consistency, and patience.
• Sexual roles are identified, sharing begins, imaginary playmates emerge, and rituals are important.
• A child can hold a cup/spoon, draw/copy a circle, balance, ride a tricycle, carry conversations, state their name, use a 900-word vocabulary, understand one idea at a time, know two colors, and imitate parental roles.

Speech and Language Development

• Children develop expressive and receptive language skills.
• They can sense someone's bad mood and withdraw and show empathy.

Autism Screening

• Lack of pointing/gesturing by 12 months, single words by 16 months, or 2-word phrases by 24 months can indicate a potential issue, also loss of achieved language and unusual object use can raise a flag.

Guidance and Discipline

• Guidance, not punishment, is key, and maintaining safety is the top priority.
• Parents should stay calm during tantrums, expectations should align with the child's abilities, and set limits using time outs and positive reinforcement.

Daily Care

• Talking at eye level and providing easy-to-remove clothing are helpful.
• Shoes should fit properly, and scoliosis risk can be influenced by posture and family factors.

Nutrition Counseling

• Caloric needs decrease to 100 cals/kg/day, milk intake should be limited to 24 oz to lower risk of anemia.
• Consistent growth in height/weight, 1 tbsp serving sizes, offering variety, and providing finger foods are helpful considerations.

Other Considerations

• Daycare must be state-approved and meet the family's preferences.
• Accident prevention involves inspecting toys, toys should be considered and curious minds are always a risk to be considered.
• Parallel and cooperative play is important for toddlers' manipulation and understanding of their environments.

Age-Appropriate Activities

• Age-appropriate activities include filling/emptying containers, supervised water play, push-pull toys, finger painting, and thick crayons.

Normal Vitals (Preschool Child: 3-5 Years)

• Respiratory rate is 20.
• Heart rate is 90-110.
• Blood pressure is 85-90/60 mmHg.

General Characteristics (Preschool Child)

• Physical growth slows during this stage, and mastery of motor, social, and cognitive abilities increases.

Major Tasks (Preschool Child)

• Major tasks include entering school, playing well with others, learning to understand functions, separating from parents, attention/memory are improved, and communication skills increase.
• Normal concentration hours are 4-10 minutes at 2 years, scaling to 25-50 minutes at 10 years.

Physical Development (Preschool Child)

• Weight doubles from age 1 by age 5, and loss of baby fat occurs between ages 3 and 6.
• All 20 primary teeth have erupted, visual acuity reaches 20/20, muscles show good control, and hand preference emerges.

Cognitive Development (Preschool Child)

• Piaget's preoperational phase includes the preconceptual stage (2-4 years) and intuitive thought stage (5-7 years).
• Symbolic functioning, egocentrism, animism, artificialism, and centering are common at this age.

Cultural Practices (Preschool Child)

• Cultural practices influence the development of a sense of initiative.

Language Development (Preschool Child)

• The number of sentences they can speak corresponds to their age.
• Delays can stem from physiological, psychological, or environmental factors.
• Receptive and expressive language skills develop.

Clinical Classification (Preschool Child): Not Talking

• Articulation disorders are evident if the child speech is not clear to everyone
• Expressive language delay may be present if the child mostly points and cannot say needs.
• Global language delay can happen if they have limited vocabulary like saying one word.
• Language disorder may present through mimicking.
• Language loss: used to say words but now says nothing

Development of Play (Preschool Child)

• Cooperative play develops, activities are complex, and children explore roles and emotional outlets.
• Magical thinking appeals to children.

Spiritual and Physical Practices (Preschool Child)

• Religious beliefs and rituals are important, and basic knowledge should be assessed before providing more information.
• Truthful and accurate explanations, and proper language use is important to note when parents begin noticing any changes.

Routine Administered Immunizations (Preschool Child)

• Varicella, DTaP, IPV, and MMR immunizations are administered.

Three-Year-Olds

• Display fewer temper tantrums, help with chores, play with toys that mimic parents' activities, dress themselves, toilet, wash hands, eat independently, speak in longer sentences, demonstrate imaginative play but may lose interest in mother, becoming more closer with fathers.
• They may have disturbed during play (remind them to go potty before play)
• There may be feelings of bodily harm (explain everything you’re doing)

Four-Year-Olds

• Are more aggressive and riskier showoff activities.
• There may be eager to express superior, pick playmates and Boisterous behavior.
• Four year olds can also use scissors and also tie their shoes, have a large vocabulary and prefer friends who have common gender
• There is an understanding of death but no relation to dying.

Five-Year-Olds

• Exhibit more responsible and patience but talk continuously and enjoys playing games.
• Deciduous teeth may start to fall out, and there are lesser fears towards the environment.

Guidance and Routine (Five-Year-Olds and Younger)

• Teach and shift from parents so that they feel more independent.
• Encourage a minute of timeout and positive reinforcement.
• Jealousy or a new sibling may cause one to feel threatened or lost.

Enuresis, Thumbsucking and Neurological Screening (Five-Year-Olds and Younger)

• Thumbsucking, discourage if before teeth.
• Secondary Enuresis, rule out any organic causes like UTIs.
• There should be neurological evaluations like counseling or bladder training.

Preschools

• A program to structure and give a child positive self esteem.

Hygiene and Accident Management (Five-Year-Olds and Younger)

• Make sure that they wear comfortable and avoid any sharp or possible chemical consumption.
• Also avoid any burns, falling, trauma, or injuries with limited supervision.

Therapeutic Play and Sensory Evaluation (Five-Year-Olds and Younger)

• Help children who may have stress, neurosensory or motor function development, stimulate them with age appropriate activities.

Nursing Implications (Five-Year-Olds and Younger)

• Tell them the truth and avoid any lying so that fears and separation is reduced, let them have as much freedom as possible.

Hearing Impairment: Infant Symptoms

• Lack of a startle reflex to sudden sounds
• Failure to respond to name or familiar sounds
• Absence of babbling or vocalization
• Delayed verbal development compared to peers

Hearing Loss: Considerations

• Older children might speak in monotone, need repeated conversations, or speak loudly due to their hearing loss
• Recommendations may include Face the child, use sign or visual, possible hearing enhancements, clear and short diction, or school programs available specifically for the hard to hear.

Scoliosis Treatment

• Curve annual screenings, observe curvature and shape of back
• 40-degree angle of spine requires postural exercise, and adolescent school care needs to address the issue properly

Otitis Media Risk Factors

• Factors include shorter, wider, straighter eustachian tubes and adenoid as well as secondhand smoke

Brain Tumor Symptoms

• Symptoms vary depending on the location and size, including increased intracranial pressure (ICP), headache, vomiting, drowsiness or loss of consciousness, seizures, nystagmus, and papilledema, diagnosed with MRI.

Seizure Types

• A partial seizure happens with complex and sensory loss

Otitis Media Treatment

• Myringotomy includes tiny tubes placed into eardrums where placement may need future speech and exam development

Hyphema Treatment

• Treatment includes bed rest with the head of the bed elevated 30-45 degrees to decrease IOP and brain ICP

Scoliosis S/S

• Asymmetry of back while child bends forward
• Prominent scapula that has should be higher than the other
• Protruding hip and one arm appears longer